how to strengthen medicare

^{4 Evidence Based Strategies for Improving Medicare}

1. Help people pick the right Medicare plans for them. Center experts found that when Medicare beneficiaries choose a prescription drug plan, poor plan choices result in extra costs and ...
2. Rethink benefit design to improve medication adherence and reduce health disparities. ...
3. Determine value in medical innovations. Policymakers acknowledge that new medical technologies can improve patient care. ...
4. Curb fragmented prescribing of opoids. Finally, our research shows fragmented prescribing of opioids is causing additional problems. ...

What does the new Medicare reform law mean for You?

There are other actions in the new law that strengthen Medicare by improving the health of those who receive benefits. These include improving outreach and coordination efforts after a patient is discharged from the hospital to prevent unnecessary hospital readmissions and reducing preventable surgical errors.

Are you worried about the solvency of Medicare?

Many people with Medicare have worried about the long-term solvency of Medicare and whether or not there would be enough funds in the program in the future to pay for care for them and their children.

When will Medicare Part A become insolvent?

The Medicare trustees project that the Part A trust fund--formally known as the Hospital Insurance Trust Fund-- will become insolvent in 2026. The fundamental problem is rising healthcare costs: The payroll tax rate that funds Part A hasn't changed since 1987, while per capita spending has doubled.

How long will the Medicare trust fund last?

These savings will protect the solvency of the Medicare Trust Fund through 2027, extending its life by 12 years. These new savings will come largely as a result of reducing excessive payments to private health insurance companies, promoting better quality of care, and cutting Medicare waste and fraud through powerful new tools.

What can be done to improve Medicare?

4 Evidence Based Strategies for Improving MedicareHelp people pick the right Medicare plans for them. ... Rethink benefit design to improve medication adherence and reduce health disparities. ... Determine value in medical innovations. ... Curb fragmented prescribing of opoids.

How can Medicare be more sustainable?

Increase co-payments from retirees – putting more of the costs of the program on retirees is another way to make Medicare more sustainable. This has already occurred by increasing the Medicare Part B premiums and increasing deductibles.

What are the 3 qualifying factors for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Why am I losing my Medicare?

Depending on the type of Medicare plan you are enrolled in, you could potentially lose your benefits for a number of reasons, such as: You no longer have a qualifying disability. You fail to pay your plan premiums. You move outside your plan's coverage area.

How can Medicare problems be resolved?

Your plan is the best resource to resolve plan related issues. Call 1-800-MEDICARE. Call 1-800-633-4227, TTY users should call 1-877-486-2048. If your concern is related to Original Medicare, or if your plan was unable to resolve your inquiry, contact 1-800-MEDICARE for help.

What challenges face the Medicare program?

Medicare's challenges are not solely financial. Medicare beneficiaries are a diverse group with diverse health care needs, and certain beneficiary populations—such as those with a disabilities or multiple chronic conditions—are particularly vulnerable to having high health care needs.

Can I get Medicare if I never worked?

You can still get Medicare if you never worked, but it will likely be more expensive. Unless you worked and paid Medicare taxes for 10 years — also measured as 40 quarters — you will have to pay a monthly premium for Part A. This may differ depending on your spouse or if you spent some time in the workforce.

What are the 4 types of Medicare?

There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.

How much does Medicare cost at age 62?

Reaching age 62 can affect your spouse's Medicare premiums He can still receive Medicare Part A, but he will have to pay a monthly premium for it. In 2020, the Medicare Part A premium can be as high as $458 per month.

How Long Will Medicare last?

A report from Medicare's trustees in April 2020 estimated that the program's Part A trust fund, which subsidizes hospital and other inpatient care, would begin to run out of money in 2026.

Can I get Medicare Part B for free?

While Medicare Part A – which covers hospital care – is free for most enrollees, Part B – which covers doctor visits, diagnostics, and preventive care – charges participants a premium. Those premiums are a burden for many seniors, but here's how you can pay less for them.

Can a Medicare Supplement plan drop you?

All Medigap policies issued since 1992 are guaranteed renewable. . This means your insurance company can't drop you unless one of these happens: You stop paying your premiums.

How many people are covered by Medicare?

Medicare is the national health insurance program that serves 62 million older adults and people with disabilities. It is key to addressing a combination of threatening, interconnected national health and economic challenges:

Why implement comprehensive staffing ratios?

Implement comprehensive staffing ratios to bring more qualified workers to care for our most vulnerable citizens.

Is Medicare privatized?

Medicare is being privatized, transformed into an assortment of individual plans, while the unified and cost-effective traditional program has been neglected.

Fix Medicare Part A

Medicare has an urgent solvency problem that impacts just one part of the program: Part A, which pays for hospital bills.

Control Drug Costs

The controversial new Alzheimer's drug OK'd by the U.S. Food and Drug Administration last year has put a bright spotlight on the issue of drug costs in Medicare.

Cover Dental, Hearing, and Vision Care

Medicare has never covered dental, hearing, or vision care, with a few exceptions. These gaping holes in care are bad for the well-being of seniors, and they lead to additional health problems that boost overall program costs. Studies have linked poor oral health with higher rates of diabetes, cardiovascular disease, and pulmonary infections.

Level the Playing Field

Medicare has been privatized on a massive scale over the past two decades, mainly through the Part D and Medicare Advantage. Advantage is on track to cover half of all enrollees by 2030, with very little public discussion of the implications for government spending and the well-being of participants.

Improve Protections for Low-Income Seniors

Affluent seniors are well-equipped to cope with the rising cost of Medicare. Higher premiums and out-of-pocket costs may be painful, but well-off seniors don't need to contemplate skipping their medications or choosing between buying groceries, rent, and healthcare bills.

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What is the core component of health care for older adults?

Vision, hearing and oral health are core components of overall well-being, but for many older adults, limited coverage of these services puts important preventative care out of reach.

What is the Health Foundation?

The Health Foundation is partnering with other organizations for an anniversary and advocacy celebration of Medicare, Medicaid, and several other important federal health care programs. Learn more, including how to register for the event, here.

Should older adults have to choose between food, rent or medical care?

No one should have to choose between affording food, rent or medical care, but for many older adults, the cost of purchasing a life-changing hearing aid or visiting a dentist is simply too great an expense.

Does Medicare cover dental?

senators are championing an expansion of Medicare benefits to include coverage of dental, vision and hearing care. The traditional Medicare program offers very limited coverage of these critically important health care services.

Does Medicare help with cancer screening?

Those without coverage are less likely to seek preventative care or diagnostic screenings that can catch cancer in an earlier, more treatable stage. The report concluded that the expansion of Medicare would improve cancer outcomes in the 60-65 age group.

How many people are covered by Medicare?

Medicare has undoubtedly helped millions of seniors and disabled adults receive health coverage since being signed into law in 1965. Today, Medicare covers 55 million beneficiaries across the US. In the coming decades though, Medicare faces a complex multitude of competing environmental pressures. First, the sheer size of the Medicare-eligible population is projected to increase significantly: according to the US census, by 2029 all the baby boomers will be 65 or older which will account for 20 percent of the US population. Adding to that increased pressure is the trends showing this population will be living with more disabilities and living longer than previous generations.

What is fragmented prescribing of opioids?

Fragmented prescribing-whereby no specific physician is solely responsible for a patient’s needs for opioid prescription-or intentional doctor shopping by patients, lead to adverse health outcomes. We found that Medicare patients who received prescription opioids from four or more unique providers had twice the annual rate of hospital admission than those who received prescription opioids from only one provider.#N#STRATEGIES IN ACTION:

What are the four evidence-based recommendations that would measurably improve the delivery of services?

Through this research four evidence-based recommendations which would measurably improve the delivery of services have been found: 1. Help people pick the right Medicare plans for them. Center experts found that when Medicare beneficiaries choose a prescription drug plan, poor plan choices result in extra costs and reduced access to necessary drugs.

How does medical technology impact healthcare?

Policymakers acknowledge that new medical technologies can improve patient care. Yet they often focus on how these new products and services put fiscal strain on government budgets rather than their benefit to society. Recently, the Medicare Payment Advisory Commission cited medical technology as having the greatest impact on health care spending. Nevertheless, medical innovations can provide health benefits that outweigh their additional costs. By applying a framework for the quality-adjusted cost of care, which takes into account both value and direct financial costs, policymakers can gain more complete insight into the value of investments from Medicare into new medical technologies that better takes into account patients’ health outcomes.

How does the Affordable Care Act affect Medicare?

The Affordable Care Act reduces the practice of paying substantially more to private insurers that contract with Medicare, than it would cost Medicare to cover those individuals in traditional Medicare. Prior to enactment of the Affordable Care Act, Medicare Advantage plans were paid about 14 percent more per patient than it would cost the program had the patient remained in traditional Medicare. The Affordable Care Act levels the playing field by gradually eliminating Medicare Advantage payments to insurance companies in excess of Medicare's costs. These changes will achieve an estimated $50 billion in savings over the next five years.

How many people are enrolled in Medicare and Medicaid?

Patients enrolled in both Medicare and Medicaid (i.e., “dual eligibles) have some of the greatest health care needs in the country, and also incur the highest health care costs as a whole. Approximately 9 million Americans are enrolled in both Medicare and Medicaid. These individuals are a small percentage of the people who receive care through these programs (16 and 15 percent respectively) but account for a disproportionate amount of spending – 27 percent of Medicare spending and 39 percent of Medicaid spending.

What is the CMS anti-fraud campaign?

The centerpiece of CMS’ anti-fraud campaign is prevention: keeping fraudulent actors out of Medicare and Medicaid in the first place. In addition to enhanced provider screening and enrollment requirements, better coordination of fraud prevention efforts, and new tools to target high-risk entities, CMS is also developing sophisticated analytic capability, using credit-card-type technology to rapidly identify fraudulent billing patterns, and networks of criminals intending to steal from these programs. These tough front-end defenses are complemented on the back end by tough new rules and sentences for criminals pursued by the Inspector General and Department of Justice. To date, the Administration’s priority on rooting out fraud and abuse is paying off. The Health Care Fraud and Abuse Control program (HCFAC) activities, including the Medicare and Medicaid Integrity Programs, resulted in a record $4 billion in recoveries, in FY2010. One HCFAC initiative, the HHS/DOJ Strike Force, has charged more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. The Affordable Care Act also provides additional tools to help prevent fraud and abuse that will achieve $1.8 billion in savings through 2015.

How does CMS save lives?

Hospitals, physicians and other health care professionals are saving lives and saving money, by working together across the health care system to solve care challenges and improve patient safety. CMS recently launched an initiative to provide strong incentives for health care providers to develop and share solutions and make those pockets of innovation the norm. CMS announced a historic investment of up to $1 billion of Affordable Care Act funding in the Partnership for Patients, which will support public-private partnerships to improve the quality, safety, and affordability of health care for all Americans. To date, more than 2,500 organizations, including 1,200 hospitals, have signed a pledge to become part of the Partnership for Patients.

What is CMS payment?

CMS has begun to implement payment methods that reward quality of care delivered , not the quantity of services provided. CMS recently finalized new payment rules to establish a value-based purchasing program for inpatient hospital services that ties hospital payment to their performance on measures. In other Medicare fee-for-service payment rules, CMS has proposed to adopt quality measures for the first time as part of a transition to a more value-based payment system. These rules have the potential to achieve even greater savings through care improvements and greater efficiencies.

Why would seniors benefit from a single deductible?

And knowing they were protected from the potentially huge costs of catastrophic illness would give seniors peace of mind—crucial benefit for those living on fixed incomes.

What is the 5th amendment?

Fifth, broaden Medicare patients’ access to specialized hospital care. There is overwhelming evidence of the positive relationship between the volume of specialized medical procedures and the quality of the care delivered. Yet the Affordable Care Act of 2010 restricted Medicare payment for services delivered by specialty and physician-owned hospitals

Should Congress work with the President to end this statutory restriction?

Congress should work with the president to end this statutory restriction, break down barriers to competition within America’s hospital markets, and permit more Medicare beneficiaries to have access to the high-value of high-volume specialized medical care.

Is Medicare site neutral?

The Trump administration has started to promote “site neutrality” in Medicare payment —a move widely applauded by conservative analysts eager to unleash greater competition within the health-care sector. Once again, however, there is support from the left as well.

Is special care important for seniors?

This is a huge barrier for seniors seeking treatment in high-tech hospitals that focus on treating special medical conditions. Specialized care is particularly valuable for patients with different kinds of cancers and chronic diseases, as well as those needing top-notch cardiac or orthopedic surgeries. Harvard Business School Professor Regina Herzlinger poses exactly the right question for Medicare patients: “Would you rather be treated by a team of people who are totally committed to the problem and all of its comorbidities, or by an everything-for-everybody kind of institution?”

Does Medicare pay for outpatient procedures?

Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. The Trump administration has started to promote “site neutrality” in Medicare payment—a move widely applauded by conservative analysts eager to unleash greater competition within the health-care sector.

Should GME be funded separately?

They should finance GME separately, instead of through the traditional Medicare program. Moreover, GME funds should be allocated to the states, but should come with the proviso that the money will follow the medical resident. This change will let states allocate funds to insure that rural and remote areas receive a sufficient number of medical residents—something that would not only benefit Medicare beneficiaries in those areas, but also broaden the training experience of new physicians.

Fix Medicare Part A

Control Drug Costs

Cover Dental, Hearing, and Vision Care

Level The Playing Field

Improve Protections For Low-Income Seniors

• Affluent seniors are well-equipped to cope with the rising cost of Medicare. Higher premiums and out-of-pocket costs may be painful, but well-off seniors don't need to contemplate skipping their medications or choosing between buying groceries, rent, and healthcare bills. But half of Medicare beneficiarieshad per capita income below $29,650 in 2019...

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